Catalano P M, Thomas A J, Huston L P, Fung C M
Department of Reproductive Biology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
Diabetes Care. 1998 Aug;21 Suppl 2:B85-90.
The objective of this work is to examine the various maternal metabolic and parental anthropometric and demographic factors that affect fetal growth and body composition. These data are a review of previously published data evaluating 1) demographic and anthropometric factors associated with fetal growth; 2) differences in male and female neonatal body composition; 3) anthropometric and maternal metabolic factors correlated with neonatal birth weight, fat-free mass, and fat mass using stepwise logistic regression analysis; and 4) the relationship between maternal weight gain and birth weight in women with normal glucose tolerance (control subjects) and gestational diabetes mellitus (GDM). We estimated body composition in 186 neonates using anthropometry. Fat-free mass, which comprised 86% of mean birth weight, accounted for 83% of the variance in birth weight, and fat mass, which comprised only 14% of birth weight, accounted for 46% of the variance in birth weight. Male neonates were, on average, 175 g heavier than females. There was significantly (P = 0.0001) greater fat-free mass in males than in females but no significant difference in fat mass. Using stepwise logistic regression, we accounted for 29% of the variance in birth weight, 30% in fat-free mass, and 17% in fat mass. Independent variables included maternal height, pregravid weight, weight gain during pregnancy, education, parity, paternal height and weight, neonatal sex, and gestational age. Including maternal glucose insulin sensitivity in 16 additional subjects, we explained 48% of the variance in birth weight, 53% in fat-free mass, and 46% in fat mass. There was a positive (P = 0.0007) correlation between weight gain and birth weight in control subjects, but a negative (P = 0.34) correlation in women with GDM. In control subjects, the correlation was strongest in women who were lean before conception and became progressively weaker as pregravid weight for height increased. In women with GDM, there were no significant correlations between maternal weight gain and birth weight, irrespective of pregravid weight for height. The assessment of fetal/neonatal body composition may improve our understanding of the effect of differential factors on fetal growth. Factors associated with accretion of fetal adipose tissue in late gestation are less well understood in comparison with birth weight and fat-free mass. Additional studies of maternal glucose and lipid metabolism are needed to better evaluate fetal growth.
这项工作的目的是研究影响胎儿生长和身体组成的各种母体代谢、父母人体测量及人口统计学因素。这些数据是对先前发表的数据的综述，评估了：1）与胎儿生长相关的人口统计学和人体测量学因素；2）男、女新生儿身体组成的差异；3）使用逐步逻辑回归分析与新生儿出生体重、去脂体重和脂肪量相关的人体测量学和母体代谢因素；4）葡萄糖耐量正常的女性（对照受试者）和妊娠期糖尿病（GDM）女性的母体体重增加与出生体重之间的关系。我们使用人体测量学方法估算了186名新生儿的身体组成。去脂体重占平均出生体重的86%，占出生体重方差的83%，而脂肪量仅占出生体重的14%，却占出生体重方差的46%。男婴平均比女婴重175克。男性的去脂体重显著高于女性（P = 0.0001），但脂肪量无显著差异。通过逐步逻辑回归分析，我们解释了出生体重方差的29%、去脂体重方差的30%和脂肪量方差的17%。自变量包括母体身高、孕前体重、孕期体重增加、教育程度、产次、父亲身高和体重、新生儿性别及孕周。在另外16名受试者中纳入母体葡萄糖胰岛素敏感性后，我们解释了出生体重方差的48%、去脂体重方差的53%和脂肪量方差的46%。对照受试者的体重增加与出生体重呈正相关（P = 0.0007），而GDM女性则呈负相关（P = 0.34）。在对照受试者中，这种相关性在孕前体型偏瘦的女性中最强，且随着身高对应的孕前体重增加而逐渐减弱。在GDM女性中，无论身高对应的孕前体重如何，母体体重增加与出生体重之间均无显著相关性。对胎儿/新生儿身体组成的评估可能会增进我们对不同因素对胎儿生长影响的理解。与出生体重和去脂体重相比，妊娠晚期与胎儿脂肪组织蓄积相关的因素了解较少。需要对母体葡萄糖和脂质代谢进行更多研究，以更好地评估胎儿生长情况。
